Learn about heart failure medication

When you have heart failure one of the cornerstones to support proper functioning of your heart is medication. The drugs that are recommended for heart failure are proven to help your symptoms, improve your outlook, and increase your life expectancy.

Some general tips on taking medication

  • Be in charge of your own medication. Know exactly what you’re taking. Understand why you are taking it.
  • Medication can sometimes make you feel worse before it makes you feel better. Don’t give up or suddenly stop taking your medication without first discussing it with your healthcare professional.
  • It can be a slow process to get to the dose of a medication that works best for you. Sometimes tablets have to be started at low doses and gradually increased. Don’t get discouraged – you will get there in the end.
  • You may need to take a lot of tablets – they’ve all got a role to play.
  • Try not to miss taking your medication and make sure you take each one on time and as recommended. A daily tablet organiser helps.
  • Remember, this is a partnership between you and your healthcare professional, so discuss how your medications are making you feel with them and if you have any questions or need any help, just ask.

ACE Inhibitors

Angiotensin Converting Enzyme Inhibitor

Types- RAMIPRIL, LISINOPRIL, ENALAPRIL, CAPTOPRIL, usually ends in ‘pril’

What do they do

ACE inhibitors are one of the major drug classes that are used in heart failure. Their role is to reduce the work load of the heart, by reducing the amount of fluid pumped around the body. They also help the heart by relaxing blood vessels, which then reduces the amount of force needed to pump blood from the heart.

Why take them

They are usually taken once a day, but occasionally your health professional may recommend that they are taken twice a day, in effect splitting the dose. When you first start on ACE inhibitors you will be started on a small dose which is gradually increased until you are on the top dose or a dose that your body is happy with. They relieve the workrate of the heart.

Potential side effects

Be prepared to have your blood pressure checked as the dose is increased, as ACE inhibitors can reduce your blood pressure, which is sometimes a good thing. However your health team will not want your blood pressure falling too low, especially if they are making you feel dizzy and unsteady. Always check things out with your health team if that is happening.

You will also have regular blood checks to ensure your kidney function is not being affected by the medication.

Occasionally you may get a dry irritable cough when you first start taking the drugs, however this often settles. If however if this persists you can always be switched to a similar drug, which follows next, which should prevent these side effects.

ARB – Angiotensin Receptor Blockers

CANDESARTAN, LOSARTAN, VALSARTAN often ending in rtan

What do they do

These drug work very similar to ACE inhibitors, and tend to be given if a patient can’t tolerate ACE inhibitors

Why take them

Again these may be taken in one dose or split dosages. The same principals apply, start low and build up gradually. They work by relaxing your blood vessels therefore enabling the heart to do less work.

Potential side effects

As with ACE inhibitors you may experience a drop in your blood pressure, so will have it checked regularly and blood tests to check your kidney function.

ARNI – Angiotensin Receptor Neprilysin Inhibitor

SACUBITRIL VALSARTAN or brand name ENTRESTO

What do they do

It works in two ways, firstly by increasing the body’s natural defences against heart failure and secondly it blocks the body’s natural system which has a harmful effect on the heart. It combines two drugs a new one called sacubitril and valsartan a drug that has been used for some time in heart failure.

Why take them

Again these may be taken in one dose or split dosages. The same principals apply, start low and build up gradually. They work by relaxing your blood vessels therefore enabling the heart to do less work.

NICE have recommended Sacubitril/valsartan for patients who have continuing symptoms of heart failure. They have related this to the New York Heart Association classification. To read more about Sacubitril Valsartan please visit our new innovation treatment page.

Potential side effects

Generally the drug is well tolerated, if there are any side effects these are likely to be light headedness due to low blood pressure, or an increase in potassium levels. This is why you will have your blood pressure and a blood test to ensure your kidneys have not been effected, including your potassium levels each time you have the drug increased. There may be other side effects, and we would recommend you reading the patient information that comes with all drugs.

Beta Blockers

Bisoprolol, Carvediolol, Nebivolol, usually end in olol.

What do they do

Beta Blockers are again a cornerstone therapy in the treatment of heart failure, their job is to make the heart beat slower but stronger, and can also be helpful with arrhythmias and angina symptoms.

Why take them

Beta Blockers may be taken once or twice a day. Again these drugs are started very slowly and gradually increased. They make your heart beat stronger therefore increasing the flow of blood around your body.

Potential side effects

They may reduce your heart rate and possibly your blood pressure, therefore you will be monitored whilst you are having these drugs introduced or increased. They can make you feel worse before they make you feel better, so hang in there, however if you are concerned, if your breathing worsens, or you are getting extremely dizzy and unsteady then speak to your health care professional.

Loop diuretic

Furoesmide, Bumetanide.

These are the first line water tablets, these are the drugs that you may have been on via a drip if you have been acutely ill in hospital.

What do they do

Patients often complain about their water tablets as they have to visit the toilet much more frequently, they are called diuretics. This is a good thing even if it can be very difficult to manage. The water tablet is getting rid of any excess fluid you may have in your body via the kidneys hence passing out more urine. The fluid can gather especially in your legs, tummy or even in your lungs, which can make you so breathless. So these tablets will make you feel better.

Why take them

You may be taking many water tablets, and more than one kind. It will depend on your symptoms, remember where you are in New York!!! You usually take them in the mornings.

All help to get rid of the surplus fluid that may gather in your body, but work on different parts of your kidneys.

Potential side effects

Well you will go to the toilet much more frequently. They can make you feel dizzy as they can reduce your blood pressure. You may experience muscle cramps.

Expect to have frequent blood tests to make sure your kidneys are working efficiently.

 

Aldosterone Antagonists / Spironolactone / Mineralocorticoid / Potassium sparing diuretics

Spironolactone or Eplerenone

These are another form of water tablet and can be very effective, but they tend to be more powerful.

What do they do

You may be taking many water tablets, and more than one kind. It will depend on your symptoms, remember where you are in New York!!! You usually take them in the mornings.

Why take them

They all help to get rid of the surplus fluid that may gather in your body, but work on different parts of your kidneys.

Potential side effects

Well you will need the toilet much more frequently. They may make you feel dizzy as they can reduce your blood pressure. You may experience muscle cramps.

With Spironolactone you may get enlarged or tender breast so discuss this with your clinician if it becomes a problem.

Expect to have frequent blood tests which will assess how well your kidneys are working, as water tablets can affect their ability to work efficiently.

Digoxin

Digoxin is a drug that has been used for a long time in cardiology.

What do they do

Its role is to strengthen the force of the heartbeat, and to help with any arrhythmia problems that you may have.

Why take them

It helps your heart beat stronger therefore this increases the flow of blood around the body.

Potential side effects

You may experience some dizziness, blurred vision, nausea or diarrhoea.

Amiodarone / Cordarone / Pacerone

What do they do

Amiodarone is used to treat an irregularity in your heartbeat which causes your heart to skip a beat, beat irregularly or beat at the wrong speed.

Why take them

If you have an arrhythmia this class of antiarrhythmic drug can help control or even reverse the rhythm irregularity. Sometimes the left ventricles pump function can be affected by an irregular rhythm these class of drug may help better pump function.

Potential side effects

You will be monitored whilst you are taking Amiodarone as occasionally you can expect side effects. Potential side effects are blurred vision, changes in the way things taste, nightmares or difficultly sleeping, upsetting how the liver works. You do have to be careful being in direct sunlight, even on a cloudy day as you can burn much more easily, ask you GP for a strong sun block. Very rarely Amiodarone has been known to cause a bluish tinge occurring on your skin, often on the face. Amiodarone has to be started at a high dose, and then gradually reduced down over a number of weeks until you are taking one tablet daily. For further information on the side effects of Amiodarone click or tap here 

Warfarin

What do they do

Warfarin lowers the risk of blood clots forming in your body by thinning your blood, it is called anticoagulation.

Why take them

Many patients with a condition called Atrial Fibrillation, which affects the rhythm, take Warfarin in order to reduce the high risk of having a Stroke. One in four people who have stroke have atrial fibrillation, taking warfarin reduces the risk.

Potential side effects

Regular blood tests are required if you take Warfarin in order to get your blood to be not too thick so that it will clot too easily and not too thin so that you clot less easily and as a result will suffer bleeding. You are likely to notice you bruise more easily.

Alternatives to warfarin – Anticoagulants

What do they do

Anticoagulants reduce the ability of the blood to clot. For further information on Apixaban, Rivaroxaban and Dabigatran please visit this page. Not ever is suitable for this type of therapy

Why take them

This is necessary if your blood clots too much which will put you at risk of a heart attack or a stroke.

Potential side effects

The major side effects are associated with excessive bleeding. To read more then click or tap this link

Ivabradine

Ivabradine or known as Procloralan

What do they do

Research has shown that in heart failure if we are able to keep the heart rate below a certain level, then heart failure patients can do better. This is often achieved by taking Beta blockers, however if they fail to do the trick then you may be started on Ivabradine to bring you heart rate to an acceptable level.

Potential side effects

They may slow your heart rate down too much so you will be monitored closely when you start them. You may experience some dizziness or a headache, it is rare but some people have complained of having visual disturbances.